Donor-derived infections-Insights from Singapore, Japan, and Thailand.

BACKGROUND: Solid organ transplantation (SOT) has expanded significantly in Asia over past few decades. Donor-derived infections (DDIs) remain a significant concern as they may adversely impact transplant outcomes. We aim to review the existing regulatory frameworks, screening protocols, and management practices for DDIs in Asia. METHODS: We reached out to transplant infectious diseases experts in Asia to provide standardized data on annual SOT numbers, incidence of DDIs, regulatory frameworks, donor and recipient screening protocols, and DDI surveillance measures. We present the data from Singapore, Japan, and Thailand. RESULTS: Donor screening for HIV, hepatitis B, hepatitis C, and syphilis is mandatory in all countries. Additionally, Japan screens for HTLV-1 antibody due to its endemicity. We also reviewed the protocols for screening and prevention of endemic infections in Asia. Singapore is the only country implementing universal screening for all donors for dengue, Zika, and chikungunya via blood and urine RT-PCR. Strongyloidiasis screening is not routinely done, although some transplant centers empirically give ivermectin prophylaxis to organ recipients. Tuberculosis screening with a donor questionnaire and chest radiograph is common for deceased donors, and some centers do Interferon Gamma Release Assay test for living donors. We also found a significant gap in the surveillance and reporting of potential DDIs in Asia and the overall incidence of DDIs in Asia is unknown and likely underreported. CONCLUSION: The experiences of Singapore, Japan, and Thailand offer valuable insights into current practices and the unmet needs regarding a DDI registry and call for coordinated efforts to address this critical issue in the region.

Improving the Communication and Understanding of the Opt-Out Organ Donation Law Among Young Adults.

Lack of knowledge adversely affects one's attitude toward organ donation. To increase understanding, Singapore informs each citizen and permanent resident turning 21 years old through information mailers sent to their place of residence. This study measured the current knowledge on organ donation of 106 polytechnic students (aged 16-24 years) and their reception toward 3 versions of the information mailers (current, revised version 1, and version 2). It was found that 69% of respondents were unaware of the Human Organ Transplant Act. The current mailer also lacks appeal, with only 3.8% of respondents preferring the current version, compared with 42% to 44% who preferred revised version 1 and 52% to 55% who preferred revised version 2. Qualitative responses suggest that the assimilation of elements in both new versions (ie, visuals, layout, and font) will likely lead to better appeal. Findings therefore reinforced the need for revision of current information mailers to captivate young adults to find out about organ donation in Singapore and make informed end-of-life decisions. Further research should consider eliciting more detailed qualitative responses in a conducive setting under a wider time frame.